Client Forms and Documents

Find the documents you’ll need as a client of Barnum Counseling.

Ali’s practice is strictly online. As with any healthcare practice, there are forms and documents you will need to read and sign before participating.

 

To view a document, click the View link below its title. To download one for signing, click on the Download links.

new therapy client information forms and documents

New Client Information Form

View         Download

new therapy client information form

Payment Authorization Form

View          Download

Insurance Authorization forms and documents

Insurance Authorization Form

View          Download

new therapy client information form

New Client Contract & Financial Agreement

View          Download

new therapy client information form

Client Privacy Policies

View          Download

fees forms for clients

Fees for Therapy Services & Good Faith Estimates

View           Download

surprise medical bills

Rights & Protections Against Surprise Medical Bills

View          Download

no surprises

No Surprises Act Notice & Consent

View          Download